Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). Paramedicine presupposes direct interaction with individuals. These factors contribute to an ethically complex decision-making environment. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Another ethical principle in paramedicine is beneficence. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). MA Healthcare Ltd However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Reflective practice is undertaken for a variety of reasons. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Ethics part 1: what do paramedics owe patients? In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Major incident clinical . Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. Although, hallucinations, delusions etc. Consequently, the crew began to assess for a psychological cause. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. This was because of current UK law and a lack of access to a GP respectively. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). In the case of paramedicine, both ethics and law should remain unprejudiced and objective. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. NHS Research and Development Permissions were sought and granted. This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. There were no obvious physical causes for John's behaviour at this stage. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. In other words, paramedics need to adopt the principle of confidentiality and credence. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. By continuing you agree to the use of cookies. Samantha May At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. | Notify the family that once CPR has been initiated, you are required to transport the patient. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). As such, making John secure was a priority. Summary. | Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). MA Healthcare Ltd Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Like the abuse of children, the abuse of older people is a significant community concern. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies This will also help you learn important concepts for the exam. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). The first concern for an EMT must be: A. patient safety. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14).